And we are now up to 5 . . . .

Republican Senators who have expressed serious "concerns" about repeal and replace. These are: Susan Collins of Maine, Rand Paul of KY, Robert Corker and Lamar Alexander, both of TN, and Tom Cotton of Arkansas.

Mind you, none of them have gone so far as to actually publicly commit against voting for "repeal and replace." But for those of us who recognize the dance, this is an opening step -- and a fairly significant one. Each defection emboldens others, especially since we are now past the point of simple Republican majority. To repeal and replace, Mitch McConnel must persuade at least 2 of them to change their mind and decide that their "concerns" are satisfied. This may be harder than expected, as there are now lots of Republican Governors who also think Congress shouldn't repeal without a replacement in hand.

Feel free to point out that they might all still fall in line. But what's up with the last minute switches? If, as I keep hearing shouted from the rooftops, Republicans just don't care about anything but repealing Obamacare and enacting the agenda on which they have been running since 2010, then why would all these guys even pretend to have last minute concerns.

Well, lets see. TN is home to the HQ of one of the largest rural hospital chains in the country. Repeal of Obamacare could potentially cost them billions of dollars.

KY and AK have huge numbers of constituents dependent on Obamacare. They also have, by taking the Medicaid expansion and embracing O-care back when they had Democratic Governors, avoided the rural hospital closing crisis that is seriously impacting SC and GA (which did not take the Medicaid expansion).

Mind you, there are plenty of changes which would still suck ass, but would be acceptable to these various interests. But rural hospitals and insurers and others with big bucks riding on losing lots of paying customers and subsidies are not known for trusting politicians on their word. This is especially true when no one has come up with a useful solution to date. The Republican proposals by and large still leave lots of people uncovered or with crappy plans, which still results in millions of paying customers for rural hospitals, drug companies, medical service suppliers, home nursing companies, etc. no longer being able to pay for these services.

That is pure loss

Why didn't anyone think of that before? Well, Democrats never made that argument. Democrats were all blah blah lives blah blah moral duty blah blah Republicans are cruel monsters who want to kill people and have them dying in the streets. Turns out, Republican (or Republican leaning) voters didn't believe this argument. They assumed that when Trump said "we will repeal Obamacare and replace it with something terrific," he was telling them what he was actually going to do -- whereas Democrats are all about making sure all those "other people" get covered and stuff.

It didn't help that the ACA has a lot of problems that a sensible, functional Congress would have addressed over the years, and therefore our Congress utterly refused to do it.

One of my dictums of advocacy. "This isn't about what argument you find compelling. It's about what convinces those you need to convince."

But it is also true that the stakeholders Republicans care about didn't focus on the studies and other things you need to get them to take these concerns seriously until it became clear that Republicans were actually serious. After all, if you are rural hospitals, why waste money on a study about something you don't think is going to happen?